RNs: who's your boss

Usually the nurse manager controls decisions regarding staff and care of the pt.

A floor R.N is in an independent role, and initiates all phases of nursing process; formulates nursing diagnosis and carries out orders of the doctor. The R.N directs LPN/LVN's and CNA's.

Most successful units work as a team.

Now when you are working say in a hospital........and your an RN, say you work on the Med-Surg unit. Do you have an immediate superior like a charge nurse that gives you assigned patients and what to do with them, or are you in charge of yourself. What I mean is do you get patient assignments and then you determine what they need as per their charts ? Or is there someone there who tells you ok, so and so will need an IV and so and so will need a cathater, and so and so needs these meds.

Or often times the RN is in charge of the CNAs?

Or is the whole unit working as a team?

There is a nurse manager. she/he (i'll say she, since my NM is a she) does the payroll, administrative stuff, etc. stuff a manager does.

There is a charge nurse every shift. not necessarily the same nurse every shift. certain nurses can be charge nurse, as designated by the NM, those who have been trained. the nurse manager makes out the patient assignment.

from then, its independent. you have your pt's, have their charts, and go by the orders on the chart, protocols, etc to decide what to do for your pt. No one is standing over your shoulder telling you "do this!" and "do this" or "your pt needs this"

At our hospital, the charge nurse on the floor assigns the patients to each nurse. I'm not sure how it works w/ the CNA's, but would guess the charge takes care of that too. There is a nursing supervisor for each shift who keeps track of how many patients are on each floor and calls in extra nurses and plans staffing for the next shift based on our census. Like the person above state, the nursing supervisor also takes care of the paperwork/business side of things.

The charge nurse makes the assignment only. I then have an automous practice, within the guidelines of the nurse practice act of course, to manage and deliver the care. So in the management of my patients, I'm the boss.